Controlled Study of Dexmedetomidine and Propofol for Sedation in Transurethral Ureteroscopic Holmium Laser Lithotripsy under Combined Spinal-Epidural Anaesthesia.

OBJECTIVE

Safety and efficacy were compared between dexmedetomidine and propofol for sedation during transurethral ureteroscopic holmium laser lithotripsy of the renal pelvis under combined spinal-epidural anaesthesia (CSEA).

METHODS

A total of 200 patients who underwent transurethral ureteroscopic holmium laser lithotripsy of the renal pelvis from March 2022 to March 2025 were selected. According to the administration methods, they were divided into the propofol group (intravenous propofol injection) and dexmedetomidine group (intravenous dexmedetomidine injection), with 100 cases in each group. Depth of sedation (Ramsay score, bispectral index (BIS) and anaesthesia tendency index (NTI)), hemodynamic parameters (heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SpO2)), postoperative recovery time (respiratory recovery time, eye-opening time and extubation time), doctor satisfaction and incidence of adverse reactions were recorded for the two groups.

RESULTS

The dexmedetomidine group had significantly higher Ramsay score at the beginning and 30 minutes after the surgery and significantly lower BIS and NTI indicators than the propofol group (p < 0.001). The fluctuation amplitude of HR and MAP was smaller, and the SpO2 level was higher (p < 0.05). Recovery time of breathing, eye-opening time and extubation time after the operation were all shorter in the dexmedetomidine group than in the propofol group (p < 0.001). The satisfaction rate of doctors was 96.00%, significantly higher than 82.00% of the propofol group (p < 0.05), and the incidence of adverse reactions was 9.00%, lower than 20.00% of the propofol group (p < 0.05).

CONCLUSIONS

In transurethral ureteroscopic holmium laser lithotripsy under CSEA, dexmedetomidine can provide a more satisfactory depth of sedation, maintain more stable hemodynamic and respiratory function, promote rapid postoperative recovery and has higher safety compared with propofol.